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General NPI Number Information
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NPI Number | 1487722716
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Entity Type | Organization
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Legal Business Name | APPLIED WELLNESS CENTER SC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 13301 S RIDGELAND AVE STE A
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-0030
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Country | US
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Telephone | 708-489-3700
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Fax | 708-489-3705
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Provider Business Mailing Address
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Address Line | 13301 S RIDGELAND AVE STE A
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-0030
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Country | US
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Telephone | 708-489-3700
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Fax | 708-489-3705
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Authorized Official
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Title or Position | BILLER
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Name | JANELLE PATTARA
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Credential |
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Telephone | 630-890-2758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 038008810
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 038.008810
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License Number State | IL
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